Dr Dace's useful links

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Quick clinical look-up and patient leaflets

Medications

Guidance on medical certification

Clinical evidence

Prostate cancer

Obstetrics and gynaecology

QOF reference

Other reference

Dental emergencies

Quackery

Vitamin supplements

Think about it. Vitamins are not magic pills. They have a correct place in the management of genuine deficiencies, in prevention of neural tube defects during the first trimester of pregnancy and in one or two other areas (all those well-covered ladies with dark skins who complain constantly of aches and pains probably need their vitamin D levels checking).

Vitamins are co-enzymes. There are many reversible biochemical reactions taking place in the body in which the presence (or absence) of a co-enzyme will tip the balance in favour of one substance or another being produced. More of this, less of that. Sometimes the body needs this, sometimes that. Are we so clever that we can interfere with this balance without having the faintest idea of all those millions of processes going on inside our bodies? That is New Age hubris.

Our only hope is to do our best to interpret the best available evidence. Hippocrates himself disparaged reliance on imaginary theory at the expense of actual observation.

Except when we have evidence to the contrary, I think it is reasonable not to interfere with the natural processes of our bodies.

Combatting abuse

Links explaining that you don't have to do every piece of unnecessary paperwork

More time-wasting - multiple prescriptions for dosette boxes

Why do GPs have to print and sign four lots of prescriptions for a patient when one would do? Well they don't.

The argument is that the extra time taken by the pharmacist to dispense medications in dosette boxes instead of bottles has to be paid for (reasonable enough) and therefore the GP should spend their time unpaid (unreasonable) to check and sign weekly prescriptions instead of monthly ones. This way the pharmacist gets paid four lots of dispensing fees for one dispensing activity (making up four dosette boxes).

However, this is wrong for a number of reasons.

Firstly, the GPs' time would be better spent thinking carefully about the patient's medication rather than signing multiple scripts, of which there may be many. This is ultimately a safety issue.

Secondly, pharmacists are already paid for this service in their existing contract. To quote from guidance from Oxfordshire PCT, With the new [2005 pharmacy] contract, additional funding was made available for community pharmacies in order that they could meet their obligation under the Disability Discrimination Act (DDA) which in some situations included the provision of an MDS. The guidance from Wessex LMC goes further and states that The pharmacists invest time into this and there has been a temptation to ask the GP to do four seven day prescriptions per month. This allows additional funds to be earned to cover the pharmacist costs. It is our view that this is an incorrect funding stream and some people within the Health Service would view at as fraudulent. Our advice is to think about what is best for your patient. Your pharmacist has a duty to consider the patient's need and supply medication appropriately. There is similar guidance from Yorkshire PCT and Hampshire.

Thirdly, as already stated, pharmacists have an obligation under the Disability Discrimination Act to dispense in compliance aids if this is necessary (rather than merely convenient) for the patient. Failure to do this where appropriate would be a breach of the law. The law is summarised on the Pharmaceutical Services Negotiating Committee web site.

Local medical links

For locums and those looking for locums

If I cannot help you, please click on www.locum123.com for locums nationally. You can also advertise your vacancy on www.lmc.org.uk, the London LMC web site.

How cool is that?

archive.coull.net/advice: Robbie Coull's advice for locums. This is an archived site - Dr Coull doesn't appear to have updated it recently. I'd still recommend you have a look. Click for Dr Coull's Locum Survival Guide.

Wizard wheezes

Disclaimer

The links on this page are to external websites over which I have no control and for which I take no responsibility.

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